Medicare Compliance & Reimbursement

CMS offers new code options for pulmonary embolisms in 2020.

Last month, the Centers for Medicare and Medicaid Services (CMS) updated the ICD-10-CM code list for 2020. The expansions, revisions, and updates include almost 400 changes and go into effect on Oct. 1. 

Background: The good news about this year’s ICD-10-CM tabular addenda, which highlights changes to the 2020 code set, is that the changes are manageable. “The 2020 Tabular Addenda is only 36 pages, some of which are mostly blank,” notes Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC.

All told, there are seven deleted codes, 328 new subcategories and codes, and 35 revised subcategories and codes. Fortunately, “there are lots of cleanup changes among these. Some are corrections from parentheses, for supplementary words, to square brackets, and for manifestations. Still others are propagation of edits and additions into corresponding advice statements. So, don’t be concerned by the overall number of changes,” says Blanchard.

Check out New Pulmonary Embolism Codes

Effective Oct. 1, you’ll find new codes that allow additional specificity in pulmonary embolism coding. The codes open up the options when seeing patients who have blood clots in their lungs. The updates apply to the I26.9 category (Pulmonary embolism without acute cor pulmonale), as follows:

• I26.93 (Single subsegmental pulmonary embolism without acute cor pulmonale)
• I26.94 (Multiple subsegmental pulmonary emboli without acute cor pulmonale)

Here’s what that means: “Cor pulmonale” refers to an abnormal enlargement of the right side of the heart due to a disease of the pulmonary blood vessels or the lungs.

The presence or absence of this added complication virtually decides the direction your coding goes in determining the final code. If the physician notes cor pulmonale during the encounter, you will select from I26.0- (Pulmonary embolism with acute cor pulmonale) and these new codes.

For example, a case of simple septic pulmonary embolism will now map to I26.93. If the physician can confirm the underlying infection, you would report this code as well. These new codes allow you to specify whether the patient has multiple emboli or just one in the absence of cor pulmonale.

Coder tip: If the provider can’t identify the type of pulmonary embolism, you have an easy way out. Pulmonary embolism not otherwise specified (NOS) will be classified to I26.99, informs Carol Pohlig, BSN, RN, CPC, ACS, Senior Coding & Education Specialist at the Hospital of the University of Pennsylvania.

Review DVT Code Expansions

Coding for deep vein thrombosis (DVT) will get a lot more detailed under ICD-10 starting in October. Here’s what you can expect.

Diagnosis: Embolism is the obstruction of a vessel by a clot or foreign substance (such as plaque or fatty deposits). Thrombosis is obstruction by a blood clot. The codes featured here are specific to deep vessels, and that means the codes are appropriate for DVT, whether the patient’s particular condition is considered acute or chronic.

Under the I82.4 (Acute embolism and thrombosis of deep veins of lower extremity) and I82.5 (Chronic embolism and thrombosis of deep veins of lower extremity) categories, ICD-10 will expand to debut four new sections:

• I82.45x (Acute embolism and thrombosis of peroneal vein): This five-code set ranges from I82.451 (… right peroneal vein) to I82.459 (… unspecified peroneal vein). These codes are site and laterality specific.
• I82.46x (Acute embolism and thrombosis of calf muscular vein): This range also includes five codes ranging from I82.461 (… right calf muscular vein) to I82.469 (… unspecified calf muscular vein), each of which is site specific to the side of the body affected.
• I82.55 (Chronic embolism and thrombosis of peroneal vein), which includes five codes from I82.551 (… right peroneal vein) to I82.559 (… unspecified peroneal vein), all describing laterality.
• I82.56 (Chronic embolism and thrombosis of calf muscular vein), which also expands out to five codes that specify laterality as above.

The codes are a welcome addition, not only because they supply some much-needed specificity. “Until now, coders could only report such conditions with other and unspecified codes, which could specify laterality, but not specify location as distal — calf — or proximal — thigh.” says Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, author of the AMA book, Risk Adjustment Documentation and Coding.

Tip: Remember, the clinician’s documentation will need to be clear about the vessel(s) and limb(s) involved for you to choose the most appropriate ICD-10 code.

See New Poisoning Code Options

If you thought the section of ICD-10 related to poisoning codes could use some help, CMS delivers with several new codes for the T50.91 section (Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances). The new section now allows you to specify the manner in which a patient was poisoned by multiple drugs, whereas in the past, there wasn’t a section that specifically noted that patients were poisoned due to a variety of drugs.

For instance, you’ll find such codes as T50.912A (Poisoning by multiple unspecified drugs, medicaments and biological substances, intentional self-harm, initial encounter) and T50.911 (Poisoning by multiple unspecified drugs, medicaments and biological substances, accidental (unintentional)).

Similar sections follow to denote adverse effects of multiple drugs (T50.915) and underdosing of multiple unspecified drugs (T50.916).

CMS Debuts New Heatstroke, Eye Fracture Codes

When you see patients for heatstroke, you currently only have the option to note the heatstroke visit, and you can’t indicate whether the visit pertains to an initial, subsequent, or sequelae-related encounter. The ICD-10 code book will now expand out sections T67.01 (Heatstroke and sunstroke), T67.02 (Exertional heatstroke), and T67.09 (Other heatstroke and sunstroke) to allow you to explain the visit stage.

And because only one code currently exists for orbital bone fractures, you’ll find several new codes for these conditions, such as 20 codes under the new subcategory S02.12 (Fracture of orbital roof), as well as over 40 new options to describe the specific site of an orbital wall fracture (S02.83 to S02.84), and seven codes to describe “fracture of orbit, unspecified” (S02.85).

Resource: To check out the complete list of new ICD-10 codes, visit the CMS website at  www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html.